TRANSMITTAL #:  133

DATE:  05/01/2013

TRICARE CHANGE #: N/A

CHAMPVA POLICY MANUAL

CHAPTER: 1

SECTION : 2.4

TITLE:  SPOUSE

AUTHORITY: Public Law 101-508; Public Law 106-117, Section 502; Public Law 107-330; and Public Law 108-183; 38 CFR 3.50, 3.52, 3.53, 3.55, 3.159, and 17.271.

RELATED AUTHORITY:  GC-Advisory 5-91 and GC Digested Opinion, 1988, WL 489710

I. EFFECTIVE DATE(S)

September 1, 1973

II. DESCRIPTION(S)

A.      A spouse is a person of the opposite sex who is married to an eligible CHAMPVA sponsor.

B.      A surviving spouse is a person of the opposite sex who was the spouse of a Veteran at the time of the Veteran’s death.

C.      Marriage.  A marriage must be valid under the State law where the parties reside.  Currently, VA recognizes only marriages of the opposite sex to qualify the spouse for DIC (Dependency and Idemnity Compensation) and other benefits.

III. POLICY

A.      A spouse or surviving spouse of a qualifying CHAMPVA sponsor is entitled to coverage for medical services as described in Chapter 2 of the CHAMPVA Policy Manual.

B.      Continuous Cohabitation and common law marriages.  Development of the issue of continuous cohabitation is addressed by the Veterans Affairs Regional Office (VARO), who will provide Chief Business OfficePurchased Care (CBOPC) with their decision concerning this matter.

1.       A determination of non-entitlement to DIC is not a bar to a determination of CHAMPVA eligibility if the spouse and Veteran (sponsor) meet all other requirements as described Chapter 1, Section 2.3, Beneficiary.

C.      Termination of Marriage.

1.       A spouse who is divorced from the sponsor loses CHAMPVA eligibility as of midnight on the date the divorce becomes final.  For example, if the divorce is effective January 1, 2001, CHAMPVA benefits cease at midnight.

2.       A spouse whose marriage to a sponsor is dissolved by annulment loses CHAMPVA eligibility as of midnight on the date the annulment order is granted.  Even though the annulment legally declares the marriage void from inception, the spouse was CHAMPVA eligible for the period prior to the annulment decree and no recoupment action is warranted based on the annulment.

D.      Remarriage.

1.       A surviving spouse who remarries loses CHAMPVA eligibility on midnight of the date of the remarriage.

2.       A surviving spouse who remarries is eligible again for CHAMPVA benefits if the remarriage is legally determined terminated by death, divorce, or annulment; however, the surviving spouse is not eligible for retroactive benefits during the annulled period.

3.       A surviving spouse who remarries and is subsequently divorced is eligible again for CHAMPVA benefits after the divorce, provided the proceedings were filed on or before October 31, 1990. [P.L. 101-508]

Note:  During the period after October 31, 1990, and prior to December 1, 1999, a surviving spouse who remarried then divorced was not authorized to reapply for CHAMPVA unless the remarriage was legally terminated by death, divorce, or annulment.

4.       A surviving spouse who remarries and the marriage is terminated by death, divorce or annulment, or who ceases living with another person with whom she/he has held publicly as a spouse, is eligible again for CHAMPVA benefits.  [Public Law 106-117]  Eligibility for CHAMPVA benefits for the surviving spouse may begin on the later of the following events:

a.       The first day of the following month after the date of death.

b.       The first day of the following month after the date the remarriage terminated (divorce or annulment).

c.        The first day of the following month after the surviving spouse ceases to live with another person who is held publicly as the spouse.

d.       December 1, 1999.

5.       Remarriage after age 55.

a.       Effective February 4, 2003, VA was authorized to allow CHAMPVA benefits to a qualifying surviving spouse who remarries after age 55. [Public Law 107-330]  

b.       The surviving spouse, who remarried before the enactment of this legislation and who was age 55 when they remarried, was required to apply for CHAMPVA benefits on or before December 31, 2004, to be considered for CHAMPVA benefits under Public Law 108-183.

(1)        When a surviving spouse who remarried after the age of 55 and before February 4, 2003, applied for DIC (Dependency and Indemnity Compensation) benefits before the deadline of December 31, 2004, the surviving spouse has satisfied the intent of the law and is eligible to be considered for CHAMPVA benefits.  

(2)        This legislation is only applicable to surviving spouses and not spouses of qualifying veteran sponsors who divorce and then remarry.

6.       CHAMPVA surviving spouses who remarry before age 55 are not entitled to CHAMPVA benefits during the period of the remarriage.

E.       Dual Eligibility.  A spouse may also be entitled to receive medical care through the VA Health Care System based on his or her own Veteran status.  In each instance where the spouse requires medical attention, the spouse may choose the VA health care system or benefit coverage under CHAMPVA for his/her health care needs, but not both for the same episode of care.  In addition, copays incurred by choosing the VA health care system cannot be submitted to CHAMPVA for reimbursement.

F.       See Chapter 1, Section 2.3, Beneficiary, for the effective qualifying dates of CHAMPVA eligibility.

IV. EXCLUSION(S)

A.      A spouse who is currently eligible for TRICARE benefits.

*END OF POLICY*